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2010-12-08-14 Answer to the case of the week #293 © Nguyen

Answer to the case of the week #293

April 28, 2011 - May 12, 2011.

Vu Dinh Nguyen, MD.

Department of Diagnostic Imaging, Hung Vuong hospital, Hi Chi Minh City, Vietnam.

Case report

This is a case of a 26 year-old woman, G1 P0, who came to our hospital for the second trimester scan at 21 weeks of her pregnancy. She had non-contributive family or personal history. The scan revealed a cardiac abnormality.
The right ventricle was dilated with extremely dilated left and right pumonary artery. The whole heart was pushed to the right side by the dilated pulmonary vessels. Ductus arteriosus could not be detected. The Doppler of the pulmonary artery should typical to-and-fro flow with high velocities on the color Doppler. Our diagnosis based on the above findings was Absent pulmonary valve syndrome. Patient opted for the pregnancy termination and declined any further examination.

Images 1,2: 4- chamber view, heart is pushed to the right. There is an anechogenic cystic structure between the heart and the left thoracic wall which gives in impression of the lung cyst.

Images 3,4: Image 3 shows the 4-chamber view. Image 4 shows the left outflow tract.


Images 5,6: Image 5 shows markedly dilated right and left pulmonary artery. Image 6 shows the turbulent flow in the pulmonary artery.

Images 7,8
: Image 7 shows dilated pulmonary arteries. Color Doppler on image 8 shows ventricular septal defect.


Images 9,10: High velocity flow in the pulmonary artery. Image 10 show a to-and-fro flow.

Videos 1,2: Video 1 shows 4-chamber view, left outflow tract, note overriding aorta and dilated pulmonary arteries pushing heart to the right. Video 2 shows sagittal view of the thorax showing pulmonary artery and aortic arch.

Videos 3,4: Color Doppler showing right outflow tract with turbulent flow in the pulmonary artery.

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